Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision-making

Rationale: Atrial fibrillation (AF) increases the risk of stroke and it can be reduced by treatment with warfarin. Some patients consider that warfarin is a stressful treatment with undesired effects and the perceived barriers include unwillingness to take it. Knowledge of patients resisting warfarin treatment may be useful for the potential threat to maintaining shared decision-making in the consultation as a central tenet of person-centered medicine. Aims and objectives: To identify how patients resist treatment with warfarin and how cardiologists respond to patients’ resistance. The co-constructive perspective of this work analyses the consultations by emphasizing the clinical communication strategies of both patients and cardiologists. Method: Eleven videotaped consultations, in 4 different hospitals, were selected for analysis. Treatment interactions regarding warfarin between patients with AF and cardiologists were analysed, according to the methodology of conversation analysis. Results: There were 4 types of resistance from patients for accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggestion of another treatment option by the patient”, “Stating a treatment preference” and “Questioning or challenging the cardiologist’s treatment recommendation”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information on the recommended treatment” and “Extending the explanation for the purpose of taking the treatment”. Conclusions: By showing resistance, patients are thought to want to participate in their treatment decisions and an awareness of patients’ resistance to treatment enables cardiologists to address the patients’ experience-based views on their treatment and individual concerns as part of clinical strategies to increase the person-centeredness of medical intervention

Configurations of sustainability‐oriented textile partnerships

Firms configure their sustainability-oriented partnerships differently depending on the sustainability issue, partnership types, and mechanisms (product, process, policy, and awareness raising) and target change at various levels (firm, industry, supply chain, and society). We study how sustainability-oriented partnerships in the textile industry are configured by analyzing 444 partnerships using a mixed-method approach. Textile firms partner to tackle environmental issues such as circularity, waste, and sustainable materials, utilizing product and process mechanisms and create firm-level change. In contrast, these firms address social issues such as education and job development, labor and working conditions, poverty, and inequality through cross-sector partnerships that target change beyond firm boundaries. We discuss these findings critically by drawing on and contributing to two literature areas: sustainability-oriented partnerships that study partnership configurations and the sustainability in textiles. Our findings highlight the importance of issue and context specificity when partnering for sustainability

Pædagogiske læreplaner i dagtilbud: Hvordan – og i hvilket omfang – inddrager pædagoger i danske daginstitutioner læreplanerne i faglige refleksioner og praksis?

Nærværende rapport beskriver resultaterne fra en undersøgelse af hvordan – og i hvilket omfang – pædagoger i danske daginstitutioner inddrager de pædagogiske læreplaner i deres faglige refleksioner og praksis. Således belyser undersøgelsen på sin vis et centralt aspekt af pædagogen som didaktiker. Metodisk er undersøgelsen gennemført som en elektronisk baseret spørgeskemaundersøgelse med en blanding af kvantitative og kvalitative elementer. Muligheder for uddybende fritekstsvar supplerede fastlagte udsagn som respondenten skulle forhold sig til på en Likert skala. Det teoretiske udgangspunkt var dynamisk didaktik, og således en forståelse af didaktik som refleksion over, gennemførsel og evaluering af planlagt pædagogisk praksis.Resultaterne peger samlet på, at de pædagogiske læreplaner spiller en væsentlig rolle for pædagogerne i deres arbejde, primært i forhold til den overordnede planlægning og refleksion, samt i forhold til dokumentation og evaluering. Læreplanerne opleves som ressourcekrævende, men som et redskab til at løfte fagligheden og kvaliteten af det pædagogiske indhold, primært indenfor det almenpædagogiske område. De fleste pædagoger oplever at have mulighed for at deltage i, og således præge, det løbende arbejde med at revidere og justere institutionens læreplan. Da resultaterne også peger på en (relativt) svag forbindelse mellem læreplanen og hverdagens planlægning, er en implikation af denne undersøgelse en videre udforskning af netop læreplanens rolle i den konkrete pædagogiske praksis

Assessing the content validity of the Manchester–Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study

Background Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients’ biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester–Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients. Methods A qualitative deductive design was used to investigate patients’ response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response. Results Seventeen respondents (65% females) were interviewed. Respondents’ age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life. Conclusions Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.publishedVersio

Sickness Behavior in Community-Dwelling Elderly: Associations with Impaired Cardiac Function and Inflammation

Sickness behavior is a cluster of symptoms that occur as a response to an infection and alterations in the inflammatory response. Under normal circumstances, sickness behavior is fully reversible once the pathogen has been cleared. Aging and chronic illness such as heart failure are associated with enhanced inflammatory activity that lasts for a long duration and no longer represents an adaptive response. The aim of this study was to explore whether inflammation mediates the relationship between impaired cardiac function and a symptom cluster including anhedonia, fatigue, and sleepiness, which might represent sickness behavior in community-dwelling elders. Structural equation modeling (SEM) showed that the factor impaired cardiac function (i.e., N-terminal fragment of pro-brain natriuretic peptide, left ventricular ejection fraction, and the heart failure medications angiotensin converting enzyme inhibitor, angiotensin receptor blockade, β-blocker, and diuretics) was associated with both inflammation (i.e., C-reactive protein; β = .26) and the symptom cluster (β = .31). Inflammation had a significant direct, but smaller, association with the symptom cluster (β = .21). By this pathway, inflammation also mediated an indirect association between impaired cardiac function and the symptom cluster (β = .05). Including creatinine, blood glucose, ischemic heart disease, previous and current tumor, respiratory disease, age, and body mass index in the SEM model did not change these associations. Our results imply that some aspects of the symptom panorama in elderly individuals with impaired cardiac function or heart failure could represent sickness behavior

Factors Associated with Undiagnosed Obstructuve Sleep Apnea in Hypertensive Primary Care Patients

Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP \u3e140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5–14.9/h) and moderate/severe (AHI \u3e 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI \u3e 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI \u3e 30 kg/m2, snoring, witnessed apnoeas, and sleep duration \u3e8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms

The Contribution of Heart Failure to Sleep Disturbances and Depressive Symptoms in Older Adults

Background: The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF). Methods: A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506). Results: Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (β = 0.64 vs β = 0.45, P = .006). Conclusion: In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms

Psychometric validation of the Persian nine-item Internet Gaming Disorder Scale – Short Form: Does gender and hours spent online gaming affect the interpretations of item descriptions?

The nine-item Internet Gaming Disorder Scale – Short Form (IGDS-SF9) is brief and effective to evaluate Internet Gaming Disorder (IGD) severity. Although its scores show promising psychometric properties, less is known about whether different groups of gamers interpret the items similarly. This study aimed to verify the construct validity of the Persian IGDS-SF9 and examine the scores in relation to gender and hours spent online gaming among 2,363 Iranian adolescents. Methods Confirmatory factor analysis (CFA) and Rasch analysis were used to examine the construct validity of the IGDS-SF9. The effects of gender and time spent online gaming per week were investigated by multigroup CFA and Rasch differential item functioning (DIF). Results The unidimensionality of the IGDS-SF9 was supported in both CFA and Rasch. However, Item 4 (fail to control or cease gaming activities) displayed DIF (DIF contrast = 0.55) slightly over the recommended cutoff in Rasch but was invariant in multigroup CFA across gender. Items 4 (DIF contrast = −0.67) and 9 (jeopardize or lose an important thing because of gaming activity; DIF contrast = 0.61) displayed DIF in Rasch and were non-invariant in multigroup CFA across time spent online gaming. Conclusions Given the Persian IGDS-SF9 was unidimensional, it is concluded that the instrument can be used to assess IGD severity. However, users of the instrument are cautioned concerning the comparisons of the sum scores of the IGDS-SF9 across gender and across adolescents spending different amounts of time online gaming

Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated

Background Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice. Methods A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed. Results The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach’s alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP. Conclusions The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence